Tubular Adenomatous Polyp in a Colon Interposition: A Case Report and Review of Literature

Abstract

Introduction: We report a case of a 59-year-old male who had a history of Barrett’s esophagus with high grade dysplasia successfully treated with colon interposition. Upper endoscopy showed a tubular adenomatous polyp of the colonic segment.Figure 2: Hematoxylin and eosin (H&E) of tubular adenomatous polyp at 100x magnification, which shows tubules that are composed of columnar cells with hyperchromatic and basally located nuclei.Adenoma and adenocarcinoma can appear as a late complication in colonic tissue grafts used to substitute the esophagus. A 59-year-old white male with a history of Barrett’s esophagus diagnosed 24 years ago, underwent esophagectomy with colonic transposition (6 years ago) for high grade dysplasia. An esophagogastroduodenoscopy (EGD) procedure was performed using an Olympus video gastroscope. The pathology report of the polyp revealed a tubular adenoma. Colonic interposition had increased morbidity, compared with gastric transposition. Screening or surveillance for colorectal cancer is a crucial preventative measure. In addition to screening colonoscopy, clinicians should perform screening upper endoscopy in patients with history of colon interposition as pathology may arise from the colonic segment. Furthermore, in the review of literature (Figure 1), 15 out of 22 patients have developed adenocarcinoma in the grafted interposed colon. Our patient was fortunate enough to be diagnosed with tubular adenoma prior to the development of advanced cancer. The emphasis of our case is to continue screening and surveillance for colon cancer wherever colonic tissue is found.Figure 1: Olympus video gastroscope shows a 0.8-cm polyp in the midportion of the interposed colon.